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NICE U-turns on 10% risk statins QOF indicator



NICE has reversed its earlier decision to recommend an indicator that would incentivise GPs to prescribe statins at a 10% primary prevention risk threshold.

Its ‘QOF menu’ that will be put forward for negotiation this year does include a revised primary prevention indicator, but crucially, it does not contain the 10% risk threshold it originally said it would put forward.

Pulse revealed earlier this month that NICE were considering withdrawing its proposal for the 10% indicator after the GPC and RCGP both come out strongly against it, with even the former chair of the QOF advisory committee saying NICE had ‘lost the plot’ on statins.

Instead, NICE has recommended some slight modifications to the current indicator that rewards practices for treating patients with a 20% risk threshold, widening it to more patients and specifying that QRISK must be used.

A 10% statins indicator will be piloted with a view to introducing it at a later stage, NICE said.

QOF advisors had previously recommended that GP practices should be incentivised for statin prescribing at the 10% risk threshold in all patients newly diagnosed with diabetes or hypertension.

What is the new indicator?

In those patients with a new diagnosis of hypertension or type 2 diabetes aged 25-84 years, recorded between the preceding 1 April to 31 March (excluding those with pre-existing CHD, diabetes, stroke and/or TIA), who have a recorded CVD risk assessment score (using the QRISK2 assessment tool) of>20% in the preceding 12 months: the percentage who are currently treated with statins (unless there is a contraindication)

Source: NICE

But the GPC said that it was ‘vital for the credibility of QOF’ that indicators have a robust evidence base, make significant difference to patients and are backed for the profession, adding that these proposals ‘fail on all these counts’.

The RCGP warned that the proposals risked ‘the loss of professional confidence in the healthcare targets they are being asked to meet’.

However, despite this, the chair of the QOF advisory – Professor Danny Keenan, a cardiothoracic surgeon – pushed the measure through, and later claimed that he had ‘no idea’ why GPs were so against the move.

But Pulse revealed this month that NICE was in talks with GP leaders about removing the threshold.

NICE said that it had ‘carefully considered’ the indicators before putting them forward, but that it would be piloting and testing further indicators on lifestyle modification, informed decision making, statins prescribing for people that have a 10% or greater 10-year CVD risk and the ‘establishment of a register that would allow the identification of people with a 10% or greater risk 10-year CVD risk’.

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said: ‘NICE is undertaking additional work to ensure that we have a suite of indicators that support the intent of the underpinning NICE guidance for lipid modification.

‘The additional work will involve testing and piloting a number of indicators, including general practice indicators that support lifestyle modification for people that have a 10% or greater 10-year CVD risk alongside indicators that measure the prescribing of statins for those with a new diagnosis of hypertension or type 2 diabetes.’